New guidelines issued by a Dept. of Health and Human Services panel say women do not need to get annual mammograms until age 50. Until now, women have been told to get a mammogram every year beginning with their 40th birthday.
The new recommendations, based on commissioned studies, say mammograms are not terribly reliable for younger women unless they have a family history of breast cancer.
The recommendations made by the U.S. Preventive Services Task Force (USPSTF) were published Tuesday. (See an
easy-to-use chart summarizing them.)
The experts say the radiation that young women are exposed to, along with the worry and testing following "false positive" reports, are not outweighed by the benefits. And they say women ages 50 to 74 only need a mammogram every two years, not annually as they have been told for years.
The panel's findings also cast major doubts on the effectiveness of breast self-exams, which may surprise many people, considering how much attention the exams are given as a prevention tool. They say teaching women to do breast self-exams does not reduce cancer deaths.
Here is the language the panel used:
Importance
- "Breast cancer is the second-leading cause of cancer death among women in the United States. Widespread use of screening, along with treatment advances in recent years, have been credited with significant reductions in breast cancer mortality."
Detection
- "Mammography, as well as physical examination of the breasts (CBE and BSE), can detect presymptomatic breast cancer. Because of its demonstrated effectiveness in randomized, controlled trials of screening, film mammography is the standard for detecting breast cancer; in 2002, the USPSTF found convincing evidence of its adequate sensitivity and specificity."
Benefits of Detection and Early Intervention
- "There is convincing evidence that screening with film mammography reduces breast cancer mortality, with a greater absolute reduction for women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years.
"Among women 75 years or older, evidence of benefits of mammography is lacking.
"Adequate evidence suggests that teaching BSE does not reduce breast cancer mortality.
"The evidence for additional effects of CBE beyond mammography on breast cancer mortality is inadequate.
"The evidence for benefits of digital mammography and MRI of the breast, as a substitute for film mammography, is also lacking."
Harms of Detection and Early Intervention
- "The harms resulting from screening for breast cancer include psychological harms, unnecessary imaging tests and biopsies in women without cancer, and inconvenience due to false-positive screening results. Furthermore, one must also consider the harms associated with treatment of cancer that would not become clinically apparent during a woman's lifetime (overdiagnosis), as well as the harms of unnecessary earlier treatment of breast cancer that would have become clinically apparent but would not have shortened a woman's life. Radiation exposure (from radiologic tests), although a minor concern, is also a consideration."
"Adequate evidence suggests that the overall harms associated with mammography are moderate for every age group considered, although the main components of the harms shift over time. Although false-positive test results, overdiagnosis, and unnecessary earlier treatment are problems for all age groups, false-positive results are more common for women aged 40 to 49 years, whereas overdiagnosis is a greater concern for women in the older age groups."
The American Cancer Society is standing by its recommendation that women should begin annual mammograms at age 40.
The (Baltimore) Sun reports
this change may affect insurance coverage of mammograms. Dr. Nagi Khouri, director of breast imaging at Johns Hopkins, said "he fears the guidelines could encourage insurance companies to back off from covering routine screening for women starting at 40."
